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Are Colon and Rectal Cancer Two Different Tumor Entities? A Proposal to Abandon the Term Colorectal Cancer. Int J Mol Sci 2018; 19:ijms19092577. [PMID: 30200215 PMCID: PMC6165083 DOI: 10.3390/ijms19092577] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/20/2018] [Indexed: 01/06/2023] Open
Abstract
Colon cancer (CC) and rectal cancer (RC) are synonymously called colorectal cancer (CRC). Based on our experience in basic and clinical research as well as routine work in the field, the term CRC should be abandoned. We analyzed the available data from the literature and results from our multicenter Research Group Oncology of Gastrointestinal Tumors termed FOGT to confirm or reject this hypothesis. Anatomically, the risk of developing RC is four times higher than CC, while physical activity helps to prevent CC but not RC. Obvious differences exist in molecular carcinogenesis, pathology, surgical topography and procedures, and multimodal treatment. Therefore, we conclude that CC is not the same as RC. The term "CRC" should no longer be used as a single entity in basic and clinical research as well as other areas of classification.
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Szymczyk P, Krajewska WM, Jakubik J, Berner A, Janczukowicz J, Mikulska U, Berner J, Kiliańska ZM. Molecular Characterization of Cellular Proteins from Colorectal Tumors. TUMORI JOURNAL 2018; 82:376-81. [PMID: 8890974 DOI: 10.1177/030089169608200416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Recent evidence has suggested that progressive stages of colorectal tumorigenesis can be defined by a sequence of genetic events characterized by altered expression of certain genes and the appearance of cancer-specific proteins. Although the significance of these events is still not clear, expression of cancer-specific protein components may be directly involved in the neoplastic transformation. The purpose of the present study was to compare molecular characteristics of cellular proteins from human colorectal tumors and normal colonic mucosa. Methods Normal mucosa and colorectal tumors from 18 patients were fractionated by a differential centrifugation scheme into four cellular fractions, i.e., nuclear, mitochondrial (10P), microsomal (100P) and cytosolic (100S). The proteins of these fractions from normal and tumorigenic mucosa were analyzed by one-dimensional polyacrylamide gel electrophoresis followed by Coomassie brilliant blue R-250 and silver nitrate staining. Nuclear proteins from normal and neoplastic tissues which had revealed the most significant diversities were further characterized by two-dimensional gel electrophoresis. Electrophoretically cancer-specific nuclear proteins in the molecular mass zone 35-40 kDa were used as immunogen to produce rabbit polyclonal antibodies. Results Electrophoretic analysis by one-dimensional gel electrophoresis showed clear differences in molecular characteristics of cellular proteins between normal and tumorigenic mucosa, especially among nuclear fractions. The latter were also confirmed by their two-dimensional electrophoresis results. Rabbit antibodies raised against electrophoretically specific nuclear proteins characterized by molecular mass of 35-40 kDa cross-reacted with 36 kDa polypeptide in 15 of 18 (83.3%) studied nuclear fractions of colorectal tumors but not with any normal mucosa. In some cases, nuclear cancer-associated components of 38 and 40 kDa were also recognized by these antibodies. Conclusions During colorectal carcinogenesis, specific expression of several nuclear proteins takes place. One of them, the polypeptide of 36 kDa not found in normal colonic epithelium, was shared by over 83% of the studied carcinomas despite variations in detailed cancer properties. This particular nuclear protein may be considered as a potential marker for the colon malignancy.
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Affiliation(s)
- P Szymczyk
- Department of Cytobiochemistry, University of Lódz, Poland
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Kim SB, Fernandes LC, Saad SS, Matos D. Assessment of the Value of Preoperative Serum Levels of CA 242 and CEA in the Staging and Postoperative Survival of Colorectal Adenocarcinoma Patients. Int J Biol Markers 2018; 18:182-7. [PMID: 14535588 DOI: 10.1177/172460080301800305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction CEA is the most frequently used tumor marker in colorectal cancer. There may be an improvement in its efficacy when used in association with CA 242. Aim The purpose of this study was to evaluate the efficacy of preoperative serum levels of the tumor markers CA 242 and CEA in the staging and postoperative follow-up of colorectal adenocarcinoma patients. Patients and Methods Of a series of 134 patients with colorectal adenocarcinomas 90 underwent radical surgery and 44 palliative surgery. The control group consisted of 22 organ donors. The cutoff serum levels utilized were 5 ng/mL for CEA and 20 U/mL for CA 242. The mortality during follow-up was recorded in order to determine the duration of survival. The data were submitted to statistical analysis using diagnostic tests, the chi-square test, survival analysis (Kaplan and Meier) and ROC curves. A significance level of p ≤ 0.05 was applied. Results The sensitivity of CEA in Dukes’ stages A, B, C and D was 27.8%, 32.4%, 32.1% and 66.7%, respectively. The sensitivity of CA 242 was 11.1%, 16.2%, 30.8% and 50%. When both markers were combined, the sensitivity was 33.3%, 48.6%, 40.7% and 72.5%. In the group of patients who underwent radical surgery the mean survival was 60.47 months for those with high preoperative CEA levels, 52.22 months for those with high preoperative CA 242 levels, and 44.80 months for those with elevated levels of both markers. There was a statistically significant difference in survival between patients undergoing radical surgery with elevated CA 242 levels, especially when CEA was also elevated, and patients without elevated CA 242. Conclusion Preoperative serum levels of CA 242 showed less efficacy than CEA levels for the staging of colorectal adenocarcinoma patients. Elevated preoperative serum levels of CA 242 alone were related to poor survival, especially in association with high levels of CEA.
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Affiliation(s)
- S B Kim
- Surgical Gastroenterology Division, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
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Zhong X, Shen H, Mao J, Zhang J, Han W. Epigenetic silencing of protocadherin 10 in colorectal cancer. Oncol Lett 2017; 13:2449-2453. [PMID: 28454418 PMCID: PMC5403191 DOI: 10.3892/ol.2017.5733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 12/20/2016] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common types of malignant tumor in the world and occurs through a multi-step process resulting from the accumulation of genetic and epigenetic alterations of the genome. Although the molecular mechanisms of the pathogenesis of CRC remain unclear, the inactivation of tumor suppressor genes (TSGs) through promoter methylation serves an important role. Aberrant methylation is a well-defined marker of CRC. At present, the epigenetic silencing of protocadherin 10 (PCDH10) has been identified as an important TSG with key roles in colorectal carcinogenesis, invasion and metastasis as a frequent and early event. Advances in gene methylation detection in tumor tissues and body fluids have led to the development of non-invasive screening methods for CRC. The present study aimed to review the epigenetic alteration of PCDH10 in CRC development, and the potential of PCDH10 to be a non-invasive biomarker for CRC.
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Affiliation(s)
- Xian Zhong
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
- Department of Medical Oncology, Hangzhou Binjiang Hospital, Hangzhou, Zhejiang 310052, P.R. China
| | - Hong Shen
- Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jianshan Mao
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jiawei Zhang
- Cancer Institute, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Weidong Han
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, P.R. China
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Bui QM, Lin D, Ho W. Approach to Lynch Syndrome for the Gastroenterologist. Dig Dis Sci 2017; 62:299-304. [PMID: 27990589 DOI: 10.1007/s10620-016-4346-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022]
Abstract
Lynch syndrome is an autosomal-dominant hereditary cancer syndrome. Mutations in mismatch repair genes, including MLH1, MSH2, MSH6, and PMS2, are implicated in the pathogenesis of the syndrome through microsatellite instability (MSI) and a rapid adenoma-carcinoma sequence. The primary methodologies for diagnosis include clinical criteria (Amsterdam I/II, Revised Bethesda Guidelines), computational models, and genetic testing (MSI, immunohistochemistry, germline testing). Universal genetic testing of colorectal cancers has gained popularity as a method to identify high-risk individuals and to offer appropriate cancer surveillance, psychological reassurance, and family planning. Management includes short-interval surveillance with colonoscopy in those without colorectal cancer and colectomy for those with cancer. Long-term chemoprevention with aspirin may improve mortality.
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Affiliation(s)
- Quan M Bui
- Department of Internal Medicine, University of California, San Diego, 330 Lewis St., San Diego, CA, 92103, USA
| | - David Lin
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 205, Los Angeles, CA, 90095, USA
| | - Wendy Ho
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 100 UCLA Medical Plaza, Suite 205, Los Angeles, CA, 90095, USA.
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Xie HQ, Zhong WZ. Outcomes of Colonic Endoscopic Mucosal Resection for Large Polyps in Elderly Patients. J Laparoendosc Adv Surg Tech A 2016; 26:707-9. [PMID: 27389049 DOI: 10.1089/lap.2015.0475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Huan-Qin Xie
- The Geriatric Ward, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China
| | - Wu-Zhuang Zhong
- The Geriatric Ward, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China
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Luboldt W, Wiedemann B, Fischer S, Bodelle B, Luboldt HJ, Grünwald F, Vogl TJ. Focal colorectal uptake in (18)FDG-PET/CT: maximum standard uptake value as a trigger in a semi-automated screening setting. Eur J Med Res 2016; 21:2. [PMID: 26749430 PMCID: PMC4706998 DOI: 10.1186/s40001-016-0195-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 01/04/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Focal colorectal uptake in (18)FDG-PET/CT may be associated with a malignancy and can be quantified. This provides the basis for an automatic trigger threshold above which cases are flagged for colonoscopic evaluation and below which for individual assessment. PURPOSE To determine the lowest maximum standard uptake (SUVmax) in colorectal cancer that could be used as a threshold to trigger endoscopic evaluation and to evaluate whether the SUVmax needs to be further normalised to a priori known extrinsic factors. METHODS The SUVmax was measured in 54 colorectal carcinomas and correlated with gender, age, blood glucose level, injected activity, body mass index and time to scan using t test or correlation coefficients (Pearson or Spearman, according to distribution). RESULTS There was no correlation between SUVmax and any of the extrinsic factors mentioned above. The lowest SUVmax value was 5 [mean ± SD (range): 11.1 ± 4.8 (5.0-24.6)]. CONCLUSION In contrast to most other screening techniques, semi-automation in colorectal screening seems possible with PET/CT. This opens the door for further study into the feasibility of automated screening. Independent from extrinsic factors, an SUVmax ≥5.0 in a focal colorectal uptake in (18)FDG-PET/CT should automatically trigger for endoscopic evaluation, if not contraindicated. Cases with SUVmax <5 should be assessed individually before referral for endoscopy. Thus, more interpretation time could be spent on those cases with a lower uptake and more ambiguous diagnosis.
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Affiliation(s)
- Wolfgang Luboldt
- Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany.
- Multiorgan Screening Foundation (www.multiorganscreening.org), Munich, Germany.
| | - Baerbel Wiedemann
- Institute of Medical Informatics and Biometry, University Hospital, Dresden, Germany.
| | - Sebastian Fischer
- Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany.
| | - Boris Bodelle
- Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany.
| | | | - Frank Grünwald
- Department of Nuclear Medicine, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany.
| | - Thomas J Vogl
- Department of Radiology, Johann Wolfgang von Goethe University Hospital, Frankfurt, Germany.
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Ding Z, Jiang T, Piao Y, Han T, Han Y, Xie X. Meta-analysis of the association between APC promoter methylation and colorectal cancer. Onco Targets Ther 2015; 8:211-22. [PMID: 25632237 PMCID: PMC4304602 DOI: 10.2147/ott.s75827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Previous studies investigating the association between adenomatous polyposis coli (APC) gene promoter methylation and colorectal cancer (CRC) have yielded conflicting results. The aim of this study was to comprehensively evaluate the potential application of the detection of APC promoter methylation to the prevention and treatment of CRC. PubMed, Embase, and MEDLINE (results updated to October 2014) were searched for relevant studies. The effect size was defined as the weighted odds ratio (OR), which was calculated using either the fixed-effects or random-effects model. Prespecified subgroup and sensitivity analyses were conducted to evaluate potential heterogeneity among the included studies. Nineteen studies comprising 2,426 participants were selected for our meta-analysis. The pooled results of nine studies comprising a total of 740 subjects indicated that APC promoter methylation was significantly associated with CRC risk (pooled OR 5.53; 95% confidence interval [CI] 3.50–8.76; P<0.01). Eleven studies with a total of 1,219 patients evaluated the association between APC promoter methylation and the presence of CRC metastasis, and the pooled OR was 0.80 (95% CI 0.44–1.46; P=0.47). A meta-analysis conducted with four studies with a total of 467 patients found no significant correlation between APC promoter methylation and the presence of colorectal adenoma (pooled OR 1.85; 95% CI 0.67–5.10; P=0.23). No significant correlation between APC promoter methylation and patients’ Dukes’ stage, TNM stage, differentiation grade, age, or sex was identified. In conclusion, APC promoter methylation was found to be significantly associated with a higher risk of developing CRC. The findings indicate that APC promoter methylation may be a potential biomarker for the carcinogenesis of CRC.
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Affiliation(s)
- Zhenyu Ding
- Department of Oncology, General Hospital of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
| | - Tong Jiang
- Laboratory of Military Health in Cold Region, Center for Disease Control and Prevention of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
| | - Ying Piao
- Department of Oncology, General Hospital of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
| | - Tao Han
- Department of Oncology, General Hospital of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
| | - Yaling Han
- Institute of Cardiovascular Disease, General Hospital of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
| | - Xiaodong Xie
- Department of Oncology, General Hospital of Shenyang Military Region, Shenyang City, Liaoning Province, People's Republic of China
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Gastrointestinal Diseases. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Disparity expression of Notch1 in benign and malignant colorectal diseases. PLoS One 2013; 8:e81005. [PMID: 24312514 PMCID: PMC3849093 DOI: 10.1371/journal.pone.0081005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Although there was growing evidence supporting the hypothesis that Notch1 was one of the few candidate genes linked with colorectal cancer (CRC) susceptibility, the precise level of Notch1 protein expression in benign and malignant colorectal diseases was still unknown. Our study has investigated the Notch1 expression in benign and malignant colorectal diseases as well as to investigate the role and clinicopathological significance of aberrant expression of Notch1 in CRC. Methods The protein expression of Notch1 was examined by immunohistochemistry in 901 clinical specimens with colorectal diseases, including 220 patients with ulcerative colitis, 232 patients with colorectal adenoma and 449 patients with colorectal cancer. Associations between the expression of Notch1 and various clinicopathological features, as well as survival status, were studied. Results Cytoplasmic Notch1 was expressed in 7.7% of patients with ulcerative colitis, 14.7% of patients with colorectal adenoma and 58.0% of patients with colorectal cancer, respectively. Colorectal cancer patients with high expression levels of Notch1 showed lower overall survival (OS) and disease-free survival (DFS) rates than those patients with low Notch1 expression. Conclusions Expression level of Notch1 was gradually increased from precancerous lesions to cancer. It might play as an oncogene in the CRC development, and might be potentially used as a biomarker for prognosis of CRCs.
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Silva TD, Vidigal VM, Felipe AV, DE Lima JM, Neto RA, Saad SS, Forones NM. DNA methylation as an epigenetic biomarker in colorectal cancer. Oncol Lett 2013; 6:1687-1692. [PMID: 24260063 PMCID: PMC3834199 DOI: 10.3892/ol.2013.1606] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/12/2013] [Indexed: 02/06/2023] Open
Abstract
Sporadic colorectal cancer (CRC) is a consequence of the accumulation of genetic and epigenetic alterations that result in the transformation of normal colonic epithelial cells to adenocarcinomas. Studies have indicated that a common event in the tumorigenesis of CRC is the association of global hypomethylation with discrete hypermethylation at the promoter regions of specific genes that are involved in cell cycle regulation, DNA repair, apoptosis, angiogenesis, adhesion and invasion. The present study aimed to investigate the epigenetic changes (DNA methylation) in 24 candidate genes in CRC. A total of 10 candidate hypermethylated (HM) and unmethylated (UM) genes were identified that may be useful epigenetic markers for non-invasive CRC screening. The five genes that had the highest average UM percentages in the control group were MLH1 (71.7%), DKK2 (69.6%), CDKN2A (68.4%), APC (67.5%) and hsa-mir-342 (67.4%). RUNX3 (58.9%), PCDH10 (55.5%), SFRP5 (52.1%), IGF2 (50.4%) and Hnf1b (50.0%) were the five genes with the highest average HM percentages in the test group. In summary, the present preliminary study identified the methylation profiles of normal and cancerous colonic epithelial tissues, and provided the groundwork for future large-scale methylation studies.
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Affiliation(s)
- Tiago Donizetti Silva
- Oncology Group, Gastroenterology Division, Federal University of São Paulo, São Paulo 04023-900, Brazil
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Ganeshan D, Elsayes KM, Vining D. Virtual colonoscopy: Utility, impact and overview. World J Radiol 2013; 5:61-7. [PMID: 23671742 PMCID: PMC3650206 DOI: 10.4329/wjr.v5.i3.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/13/2012] [Accepted: 01/31/2013] [Indexed: 02/06/2023] Open
Abstract
Computed tomography (CT) colonoscopy is a well-established technique for evaluation of colorectal cancer. Significant advances have been made in the technique of CT colonoscopy since its inception. Excellent results can be achieved in detecting both colorectal cancer and significant sized polyps as long as a meticulous technique is adopted while performing CT colonoscopy. Furthermore, it is important to realize that there is a learning curve involved in interpreting these studies and adequate experience is essential to achieve high sensitivity and specificity with this technique. Indications, contraindications, technique and interpretation, including potential pitfalls in CT colonoscopy imaging, are reviewed in this article. Recent advances and the current role of CT colonoscopy in colorectal cancer screening are also discussed.
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Jana S, Patel H. Expression of human granulocyte colony stimulating factor (hG-CSF) in colon adenocarcinoma cell line (Caco-2). Biotechnol Lett 2012; 34:1791-6. [PMID: 22714276 PMCID: PMC3483470 DOI: 10.1007/s10529-012-0977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/25/2012] [Indexed: 11/25/2022]
Abstract
Growth and progression of many cancer cells are mediated by alterations in the microenvironment often caused by an aberrant expression of growth factors and receptors. There is no report on expression of growth factor granulocyte colony-stimulating factor (G-CSF) in the experimental model, colon adenocarcinoma cell line (Caco2), that is commonly used in drug permeability assays. We hypothesize that in vitro, the Caco2 model is associated with a constitutive neo-expression of the hematopoietic G-CSF thereby causing an autocrine stimulation of Caco2 growth and proliferation in vitro. To test our hypothesis, we analyzed mRNA and protein expression of G-CSF in Caco2 cells using reverse transcriptase-PCR and SDS-PAGE. G-CSF mRNA and protein were detected in Caco2 cells. Expression of G-CSF protein was similar at different passages of this cell line. The expression of G-CSF has a significant role in the autocrine regulation of Caco2 cell growth and proliferation.
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Affiliation(s)
- Snehasis Jana
- Drug Metabolism and Pharmacokinetics-Toxicology Division, Sai Advantium Pharma Ltd, Building 1, Plot No 2, Chrysalis Enclave, International Biotech Park, Phase-II, Hinjewadi, Pune 411057, India.
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Fijneman RJA, de Wit M, Pourghiasian M, Piersma SR, Pham TV, Warmoes MO, Lavaei M, Piso C, Smit F, Delis-van Diemen PM, van Turenhout ST, Terhaar sive Droste JS, Mulder CJJ, Blankenstein MA, Robanus-Maandag EC, Smits R, Fodde R, van Hinsbergh VWM, Meijer GA, Jimenez CR. Proximal fluid proteome profiling of mouse colon tumors reveals biomarkers for early diagnosis of human colorectal cancer. Clin Cancer Res 2012; 18:2613-24. [PMID: 22351690 DOI: 10.1158/1078-0432.ccr-11-1937] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Early detection of colorectal cancer (CRC) and its precursor lesions is an effective approach to reduce CRC mortality rates. This study aimed to identify novel protein biomarkers for the early diagnosis of CRC. EXPERIMENTAL DESIGN Proximal fluids are a rich source of candidate biomarkers as they contain high concentrations of tissue-derived proteins. The FabplCre;Apc(15lox/+) mouse model represents early-stage development of human sporadic CRC. Proximal fluids were collected from normal colon and colon tumors and subjected to in-depth proteome profiling by tandem mass spectrometry. Carcinoembryonic antigen (CEA) and CHI3L1 human serum protein levels were determined by ELISA. RESULTS Of the 2,172 proteins identified, quantitative comparison revealed 192 proteins that were significantly (P < 0.05) and abundantly (>5-fold) more excreted by tumors than by controls. Further selection for biomarkers with highest specificity and sensitivity yielded 52 candidates, including S100A9, MCM4, and four other proteins that have been proposed as candidate biomarkers for human CRC screening or surveillance, supporting the validity of our approach. For CHI3L1, we verified that protein levels were significantly increased in sera from patients with adenomas and advanced adenomas compared with control individuals, in contrast to the CRC biomarker CEA. CONCLUSION These data show that proximal fluid proteome profiling with a mouse tumor model is a powerful approach to identify candidate biomarkers for early diagnosis of human cancer, exemplified by increased CHI3L1 protein levels in sera from patients with CRC precursor lesions.
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Affiliation(s)
- Remond J A Fijneman
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
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Luboldt W, Volker T, Wiedemann B, Zöphel K, Wehrmann U, Koch A, Toussaint T, Abolmaali N, Middendorp M, Aust D, Kotzerke J, Grünwald F, Vogl TJ, Luboldt HJ. Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off. Eur Radiol 2010; 20:2274-85. [PMID: 20503051 PMCID: PMC2914265 DOI: 10.1007/s00330-010-1772-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 02/16/2010] [Accepted: 02/19/2010] [Indexed: 12/21/2022]
Abstract
Objective: To determine the performance of FDG-PET/CT in the detection of relevant colorectal neoplasms (adenomas ≥10 mm, with high-grade dysplasia, cancer) in relation to CT dose and contrast administration and to find a PET cut-off. Methods: 84 patients, who underwent PET/CT and colonoscopy (n = 79)/sigmoidoscopy (n = 5) for \documentclass[12pt]{minimal}
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\begin{document}$${\left( {{\hbox{79}} \times {\hbox{6}} + {\hbox{5}} \times {\hbox{2}}} \right)} = {\hbox{484}}$$\end{document} colonic segments, were included in a retrospective study. The accuracy of low-dose PET/CT in detecting mass-positive segments was evaluated by ROC analysis by two blinded independent reviewers relative to contrast-enhanced PET/CT. On a per-lesion basis characteristic PET values were tested as cut-offs. Results: Low-dose PET/CT and contrast-enhanced PET/CT provide similar accuracies (area under the curve for the average ROC ratings 0.925 vs. 0.929, respectively). PET demonstrated all carcinomas (n = 23) and 83% (30/36) of relevant adenomas. In all carcinomas and adenomas with high-grade dysplasia (n = 10) the SUVmax was ≥5. This cut-off resulted in a better per-segment sensitivity and negative predictive value (NPV) than the average PET/CT reviews (sensitivity: 89% vs. 82%; NPV: 99% vs. 98%). All other tested cut-offs were inferior to the SUVmax. Conclusion: FDG-PET/CT provides promising accuracy for colorectal mass detection. Low dose and lack of iodine contrast in the CT component do not impact the accuracy. The PET cut-off SUVmax ≥ 5 improves the accuracy.
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A study on MSH2 and MLH1 mutations in hereditary nonpolyposis colorectal cancer families from the Basque Country, describing four new germline mutations. Fam Cancer 2010; 8:533-9. [PMID: 19760518 DOI: 10.1007/s10689-009-9283-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome underlies between 2 and 5% of all colorectal cancer. It is inherited as an autosomal dominant condition due to mutations in the mismatch repair genes. Fifty-four non-related index cases, 21 of them fulfilling Amsterdam criteria I or II, were studied. Ten (10/21 = 47.6%) different pathological mutations were found in this group, two of which had not previously been reported--one in MLH1 and the other in MSH2-. In the remaining patients, we also found another family with one of these new mutations, and four additional changes, two of which were also new--a pathological change in MSH2 and a second change of uncertain significance in MLH1-, while the other two changes had already been reported. Of all mutations, eight were found in MSH2 (8/15 = 53.3%) and seven in MLH1 (7/15 = 46.6%), suggesting a slightly greater involvement of MSH2 in HNPCC than MLH1 in our population, in contrast to the results reported by other authors.
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Janda M, Hughes K, Tong S, Stanton WR, Aitken J, Clavarino A, Short L, Mar CD, Leggett B, Newman B. FAECAL OCCULT BLOOD TEST: CURRENT PRACTICE IN A RURAL QUEENSLAND COMMUNITY. Aust J Rural Health 2008. [DOI: 10.1111/j.1440-1584.2002.tb00010.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ayanian JZ, Sequist TD, Zaslavsky AM, Johannes RS. Physician reminders to promote surveillance colonoscopy for colorectal adenomas: a randomized controlled trial. J Gen Intern Med 2008; 23:762-7. [PMID: 18386103 PMCID: PMC2517870 DOI: 10.1007/s11606-008-0576-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 01/31/2008] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Most colorectal cancers develop from adenomatous polyps. National guidelines recommend surveillance colonoscopy within 5 years after such polyps are removed. OBJECTIVE To determine whether surveillance colonoscopy can be increased among overdue patients by reminders to their primary physicians. DESIGN Randomized, controlled trial of patient-specific reminders mailed to 141 physicians in 2 Massachusetts primary care networks during April, 2006. PATIENTS Seven hundred seventeen patients who had colorectal adenomas removed during 1995 through 2000 and no follow-up colonoscopy identified via automated review of electronic records through March, 2006. MEASUREMENTS AND MAIN RESULTS The use of colonoscopy and detection of new adenomas or cancer were assessed at 6 months by a blinded medical record review in all patients. Among 358 patients whose physicians received reminders, 33 (9.2%) patients underwent colonoscopy within 6 months, compared with 16 (4.5%) of 359 patients whose physicians did not receive reminders (P = 0.009). In prespecified subgroups, this effect did not differ statistically between 2 primary care networks, elderly and nonelderly patients, or women and men (all P > 0.60 by Breslow-Day test). New adenomas or cancer were detected in 14 (3.9%) intervention patients and 6 (1.7%) control patients (P = 0.06), representing 42.4% and 37.5% of patients who underwent colonoscopy in each group, respectively. Despite using advanced electronic health records to identify eligible patients, 22.5% of enrolled patients had a prior follow-up colonoscopy ascertained only by visual record review, and physicians reported 27.9% of intervention patients were no longer active in their practice. CONCLUSIONS Among patients with prior colorectal adenomas, physician reminders increased the use of surveillance colonoscopy, but better systems are needed to identify eligible patients (ClinicalTrials.gov ID number NCT00397969).
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Affiliation(s)
- John Z Ayanian
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Sundaram P, Zomorodian A, Beaulieu C, Napel S. Colon polyp detection using smoothed shape operators: preliminary results. Med Image Anal 2007; 12:99-119. [PMID: 17910934 DOI: 10.1016/j.media.2007.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 07/25/2007] [Accepted: 08/03/2007] [Indexed: 10/22/2022]
Abstract
Computer-aided detection (CAD) algorithms identify locations in computed tomographic (CT) images of the colon that are most likely to contain polyps. Existing CAD methods treat the CT data as a voxelized, volume image. They estimate a curvature-based feature at the mucosal surface voxels. However, curvature is a smooth notion, while our data are discrete and noisy. As a second order differential quantity, curvature amplifies noise. In this paper, we present the smoothed shape operators method (SSO), which uses a geometry processing approach. We extract a triangle mesh representation of the colon surface, and estimate curvature on this surface using the shape operator. We then smooth the shape operators on the surface iteratively. Throughout, we use techniques explicitly designed for discrete geometry. All our computation occurs on the surface, rather than in the voxel grid. We evaluate our algorithm on patient data and provide free-response receiver-operating characteristic performance analysis over all size ranges of polyps. We also provide confidence intervals for our performance estimates. We compare our performance with the surface normal overlap (SNO) method for the same data. A preliminary evaluation of our method on 35 patients yielded the following results (polyp diameter range; sensitivity; false positives/case): (10mm; 100%; 17.5), (5-10 mm; 89.7%, 21.23), (<5 mm; 59.1%; 23.9) and (overall; 80.3%; 23.9). The evaluation of the SNO method yielded: (10 mm; 75%; 17.5), (5-10 mm; 43.1%; 21.23), (<5 mm; 15.9%; 23.9) and (overall; 38.5%; 23.9).
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Affiliation(s)
- P Sundaram
- Department of Radiology, Stanford University, Stanford, CA 94305, United States.
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Chung SJ, Kim JS, Jung HC, Song IS. Transforming growth factor-[beta]1 -509T reduces risk of colorectal cancer, but not adenoma in Koreans. Cancer Sci 2007; 98:401-4. [PMID: 17214746 PMCID: PMC11159075 DOI: 10.1111/j.1349-7006.2007.00401.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The proliferation of colorectal epithelial cells is regulated by various stimuli including cytokines and growth factors, thus the variants of those genes can modify the colorectal cancer risk. TGF-[beta]1 can act as both a tumor suppressor and a stimulator of tumor progression. TGF-[beta]1 C-509T polymorphism in the promoter sequence has been associated with increased levels of plasma TGF-[beta]1 in individuals with T allele. To evaluate the potential influences of this polymorphism on colorectal adenoma and cancer risk, a case-control study was conducted in Korea. A total of 646 subjects were prospectively enrolled in Seoul National University Hospital. Risk of colorectal neoplasms was evaluated separately for 244 patients with colorectal adenoma, 152 patients with colorectal cancer relative to 250 healthy controls. Genotypes were determined by the PCR-RFLP method. ORs and 95% CIs were calculated by a multivariate logistic regression analysis. The TGF-[beta]1 -509T allele containing genotypes posed a reduced risk of colorectal cancer (adjusted OR = 0.59, 95% CI = 0.28-0.92). But there was no association between this polymorphism and colorectal adenoma. Our results suggest that the TGF-[beta]1 -509T allele may have a protective role in the development of colorectal cancer, possibly consistent with its role as an inhibitor of epithelial malignant transformation.
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Affiliation(s)
- Su J Chung
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 110-744, Korea
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Haykir R, Karakose S, Karabacakoglu A, Sahin M, Kayacetin E. Three-dimensional MR and axial CT colonography versus conventional colonoscopy for detection of colon pathologies. World J Gastroenterol 2006; 12:2345-50. [PMID: 16688823 PMCID: PMC4088068 DOI: 10.3748/wjg.v12.i15.2345] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the sensitivity and specificity of MR colonography (MRC) and CT performance in detecting colon lesions, and to compare their sensitivity and specificity with that of conventional colonoscopy.
METHODS: Forty-two patients suspected of having colonic lesions, because of rectal bleeding, positive fecal occult blood test results or altered bowel habits, underwent the examinations. After insertion of a rectal tube, the colon was filled with 1000-1500 mL of a mixture of 9 g/L NaCl solution, 15-20 mL of 0.5 mmol/L gadopentetate dimeglumine and 100 mL of iodinized contrast material. Once colonic distension was achieved, three-dimensional gradient-echo (3D-GRE) sequences for MR colonography and complementary MR images were taken in all cases. Immediately after MR colonography, abdominal CT images were taken by spiral CT in the axial and supine position. Then all patients were examined by conventional colonoscopy (CC).
RESULTS: The sensitivity and specificity of MRC for colon pathologies were 96.4% and 100%, respectively. The percentage of correct diagnosis by MRC was 97.6%. The sensitivity and specificity of CT for colon pathologies were 92.8%, 100%, respectively. The percentage of correct diagnosis by CT was 95.2%.
CONCLUSION: In detecting colon lesions, MRC achieved a diagnostic accuracy similar to CC. However, MRC is minimally invasive, with no need for sedation or analgesics during investigation. There is a lower percentage of perforation risk, and all colon segments can be evaluated due to multi-sectional imaging availability; intramural, extra-intestinal components of colonic lesions, metastasis and any additional lesions can be evaluated easily. MRC and CT colonography are new radiological techniques that promise to be highly sensitive in the detection of colorectal mass and inflammatory bowel lesions.
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Affiliation(s)
- Rahime Haykir
- Department of Radiology, Selcuk University Meram Medical Faculty, Konya 42080, Turkey
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23
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Huang CS, Lal SK, Farraye FA. Colorectal cancer screening in average risk individuals. Cancer Causes Control 2005; 16:171-88. [PMID: 15868457 DOI: 10.1007/s10552-004-4027-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2004] [Accepted: 09/30/2004] [Indexed: 02/07/2023]
Abstract
Colorectal cancer is the third leading type of cancer, and the second leading cause of cancer-related death in the United States. Prevention of colorectal cancer should be achievable by screening programs that detect adenomas in asymptomatic patients and lead to their removal. In this manuscript, we review the major screening modalities, the advantages and disadvantages of each approach, the data supporting their use, and various issues affecting the implementation of each test. Screening guidelines will be reviewed, and future techniques for colorectal cancer screening examined.
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Kong SL, Salto-Tellez M, Leong APK, Chan YH, Koay ESC. Discordant quantitative detection of putative biomarkers in nodal micrometastases of colorectal cancer: biological and clinical implications. J Clin Pathol 2005; 58:839-44. [PMID: 16049286 PMCID: PMC1770861 DOI: 10.1136/jcp.2004.023853] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Nodal expression of the carcinoembryonic antigen (CEA), cytokeratin 20 (CK20), and guanylyl cyclase C (GCC) genes was measured in tandem in patients with colorectal cancer (CRC) to assess whether there would be sufficient agreement between these markers in their ability to detect micrometastasis to qualify one of them as a universal marker, and whether frozen and paraffin wax embedded tissues would yield similar results. METHODS One hundred and seventy five frozen lymph nodes (FT) and 158 formalin fixed, paraffin wax embedded lymph nodes (PET) from 28 CRC cases were analysed using gene specific quantitative real time polymerase chain reaction, carried out on the LightCycler system with SYBR Green chemistry. RESULTS There was significant disparity in positive detection of the three biomarkers in FT versus PET, with notable agreement achieved only for CEA (66.6%) in FT versus PET in Dukes' B disease, and between CK20 and GCC (44.6%) in FT, also in Dukes' B disease. One patient with full concordance in all three tumour markers with both tissue types suffered a relapse and died within two years of follow up. CONCLUSIONS There was considerable discordance in the positive detection of the three tumour markers in both tissue types (FT versus PET). This brings into question whether using a single tumour marker to detect micrometastasis in one tissue type (FT or PET) is adequately representative, and challenges the concept of universal markers for molecular CRC metastatic detection. Multiple tumour markers would predict more accurately the metastatic potential of Dukes' B CRCs.
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Affiliation(s)
- S L Kong
- Department of Pathology, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260
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25
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Olson J, Whitney DH, Durkee K, Shuber AP. DNA Stabilization Is Critical for Maximizing Performance of Fecal DNA-Based Colorectal Cancer Tests. ACTA ACUST UNITED AC 2005; 14:183-91. [PMID: 16106201 DOI: 10.1097/01.pas.0000176768.18423.7e] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We have developed a multitarget, fecal DNA screening assay that detects the presence of gene-specific mutations and long DNA fragments associated with colorectal cancer (CRC). We continue to investigate methods that may be used to optimize clinical sensitivity. The goals of this investigation are to establish how sample handling conditions affect the stability of DNA in stool, thereby potentially limiting clinical sensitivity, and to determine conditions to ameliorate DNA degradation. A study was run comparing paired sample aliquots. Quantitative PCR data for matched aliquots was used to determine first the effect of sample incubation on total recovery and integrity of DNA, then the effect of stabilization buffer addition to stool on recoverable DNA, and finally the impact of buffer addition on assay sensitivity. Comparison of quantitative PCR data for paired aliquots shows that the amount of recoverable human DNA is negatively affected by storing stool samples (N = 43) at room temperature for > or =36 hours (P = 0.0018). However, the addition of stabilization buffer leads to a significant increase in recovery of DNA (P = 0.010), compared with samples incubated without buffer. Whereas the DNA Integrity Assay (DIA) is found to be sensitive to DNA degradation (sensitivity was reduced by 82%; P = 0.0002), point mutation marker sensitivity is more refractory. Overall, DNA can be stabilized by addition of buffer to the sample, leading to increased assay sensitivity.
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Affiliation(s)
- Jeff Olson
- Exact Sciences Corporation, Marlborough, MA 01752, USA
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Erturk SM, Mortelé KJ, Oliva MR, Barish MA. State-of-the-art computed tomographic and magnetic resonance imaging of the gastrointestinal system. Gastrointest Endosc Clin N Am 2005; 15:581-614, x. [PMID: 15990058 DOI: 10.1016/j.giec.2005.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Among the major innovations in radiology of the gastrointestinal (GI) system are the replacement of classic invasive diagnostic methods with noninvasive ones and the improvement in lesion characterization and staging of pancreatobiliary malignancies. Developments in imaging technology have led to many improvements in the field of diagnostic GI radiology. With its fast and thin-section scanning abilities, multidetector-row CT (MDCT) strengthens the place of CT as the most efficient tool to diagnose, characterize, and preoperatively stage pancreatic neoplasms. MR cholangiopancreatography has widely replaced endoscopic retrograde cholangiopancreatography in the diagnosis and staging of pancreatobiliary malignancies. MR imaging, using phased-array or endorectal coils, demonstrates local tumor invasion accurately in rectal cancers and thus allows an improved surgical planning. Virtual colonoscopy with MDCTs is an efficient screening method for colon cancer, and MDCT enterography is becoming the standard imaging technique for many small bowel disorders. The continuing developments in CT and MR technology will most probably further improve the accuracy of these and other imaging applications in the near future.
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Affiliation(s)
- Sukru Mehmet Erturk
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Fidder HH, Figer A, Zidan J, Meir SB, Friedman E. Colonic Adenomas Do Not Cosegregate with the I1307K APC Missense Mutation in an Israeli Non-Ashkenazi Family. Dig Dis Sci 2005; 50:52-55. [PMID: 27837393 DOI: 10.1007/s10620-005-1277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2004] [Accepted: 07/28/2004] [Indexed: 12/09/2022]
Affiliation(s)
- Herma H Fidder
- Institute of Gastroenterology, Danek Gertner Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Arie Figer
- Institute of Oncology, Tel-Aviv Elias Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Jamal Zidan
- The Oncology Unit, Rivkah Ziv Medical Center, Zefat, Israel.,Bruce Rappaport Medical School, Technion Haifa, Israel
| | - Shimon Bar Meir
- Institute of Gastroenterology, Danek Gertner Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Eitan Friedman
- Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel. , .,Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel. ,
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Mangold E, Pagenstecher C, Friedl W, Mathiak M, Buettner R, Engel C, Loeffler M, Holinski-Feder E, Müller-Koch Y, Keller G, Schackert HK, Krüger S, Goecke T, Moeslein G, Kloor M, Gebert J, Kunstmann E, Schulmann K, Rüschoff J, Propping P. Spectrum and frequencies of mutations inMSH2 andMLH1 identified in 1,721 German families suspected of hereditary nonpolyposis colorectal cancer. Int J Cancer 2005; 116:692-702. [PMID: 15849733 DOI: 10.1002/ijc.20863] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mutations in DNA MMR genes, mainly MSH2 and MLH1, account for the majority of HNPCC, an autosomal dominant predisposition to colorectal cancer and other malignancies. The evaluation of many questions regarding HNPCC requires clinically and genetically well-characterized HNPCC patient cohorts of reasonable size. One main focus of this multicenter study is the evaluation of the mutation spectrum and mutation frequencies in a large HNPCC cohort in Germany; 1,721 unrelated patients, mainly of German descent, who met the Bethesda criteria were included in the study. In tumor samples of 1,377 patients, microsatellite analysis was successfully performed and the results were applied to select patients eligible for mutation analysis. In the patients meeting the strict Amsterdam criteria (AC) for HNPCC, 72% of the tumors exhibited high microsatellite instability (MSI-H) while only 37% of the tumors from patients fulfilling the less stringent criteria showed MSI-H; 454 index patients (406 MSI-H and 48 meeting the AC of whom no tumor samples were available) were screened for small mutations. In 134 index patients, a pathogenic MSH2 mutation, and in 118 patients, a pathogenic MLH1 mutation was identified (overall detection rate for pathogenic mutations 56%). One hundred sixty distinct mutations were detected, of which 86 are novel mutations. Noteworthy is that 2 mutations were over-represented in our patient series: MSH2,c.942+3A>T and MLH1,c.1489_1490insC, which account for 11% and 18% of the MSH2 and MLH1 mutations, respectively. A subset of 238 patients was screened for large genomic deletions. In 24 (10%) patients, a deletion was found. In 72 patients, only unspecified variants were found. Our findings demonstrate that preselection by microsatellite analysis substantially raises mutation detection rates in patients not meeting the AC. As a mutation detection strategy for German HNPCC patients, we recommend to start with screening for large genomic deletions and to continue by screening for common mutations in exon 5 of MSH2 and exon 13 of MLH1 before searching for small mutations in the remaining exons.
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Anwar S, Frayling IM, Scott NA, Carlson GL. Systematic review of genetic influences on the prognosis of colorectal cancer. Br J Surg 2004; 91:1275-91. [PMID: 15382104 DOI: 10.1002/bjs.4737] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Background
In terms of genetics, colorectal cancer is one of the best understood of all malignant diseases. Genetic influences on prognosis may have far-reaching implications, especially for the design of surgical and chemoradiotherapeutic regimens. However, their significance in determining prognosis remains unclear. This study aimed to review the literature on the specific role of key genes in determining the survival of patients with colorectal cancer.
Methods
A Medline search was carried out to identify all original scientific papers relating colorectal cancer genetics to patient survival, up to December 2002. Cochrane and Embase databases were also searched. Identified articles were retrieved and searched carefully for additional information. This review includes K-ras, p53, DCC, NM23 and DNA mismatch repair genes.
Results and conclusion
Conflicting evidence exists as to the prognostic significance of genes commonly implicated in the pathogenesis of colorectal carcinoma. Possible causes for such discrepancy include differences in study methods and laboratory techniques, variable duration of follow-up, statistical differences in study power, and heterogeneity in study populations. Future studies should adopt standardized protocols to define clinically relevant genetic observations.
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Affiliation(s)
- S Anwar
- Department of Colorectal Surgery, Hope Hospital, Salford, UK
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Lenander C, Roblick UJ, Habermann JK, Ost A, Tryggvason K, Auer G. Laminin 5 gamma 2 chain expression: a marker of early invasiveness in colorectal adenomas. Mol Pathol 2004; 56:342-6. [PMID: 14645697 PMCID: PMC1187353 DOI: 10.1136/mp.56.6.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM Polyps of the colon and rectum are considered to be premalignant lesions in the development of colorectal cancer. However, knowledge of how normal epithelial cells gain invasive properties is limited. Laminin 5 gamma 2 chain expression was investigated to determine the role of laminin 5 as a marker of potential invasiveness in colorectal polyps. MATERIAL/METHODS Sixty seven polyps of different types (15 hyperplastic polyps, 12 serrated adenomas, 16 tubular adenomas, and 24 adenomas with a villous component) were assessed for gamma 2 chain expression of laminin 5 by immunohistochemistry on archival, paraffin wax embedded sections. RESULTS Ten polyps stained positive and the number of polyps expressing the laminin 5 gamma 2 chain increased significantly as the phenotype of the adenomas became more atypical: none of the 15 hyperplastic polyps, two of the 16 tubular adenomas (12.5%), and six of the 24 adenomas with a villous component (25%) were positive. Two of 12 (17%) serrated adenomas, regarded as a distinct form of colorectal neoplasia, showed gamma 2 chain expression. Furthermore, laminin 5 gamma 2 chain expression correlated with lesion size. Polyps smaller than 10 mm expressed the gamma 2 chain less frequently than did those equal to or larger than 10 mm. CONCLUSION Laminin 5 gamma 2 chain expression was found to increase progressively towards a more atypical phenotype of adenoma. The results suggest that, in the future, laminin 5 gamma 2 chain expression may be used as an indicator of incipient malignant transformation of a benign colorectal adenoma.
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Affiliation(s)
- C Lenander
- Centre of Gastrointestinal Disease, Department of Surgery, Ersta Hospital, S-11691, Stockholm, Sweden.
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Abstract
Studies have recorded significant patient discomfort during flexible sigmoidoscopy when it is performed without sedation/analgesia. This study observed whether a single dose of 50 mcg intravenous fentanyl reduces pain, improving compliance, acceptability, and completion rates. In a prospective study, 109 consecutive patients were offered the option of 50 mcg intravenous fentanyl or no analgesia. Patient's pre-procedure expectations, objective pain scores, and willingness to undergo a subsequent procedure using the same technique were recorded. Endoscopist recorded the success, complications, and objective pain scores for each patient. Of the 46 patients (42%) choosing fentanyl, 9 (20%) experienced moderate/severe pain as against 26 (41%) of the 63 patients (58%) opting for no analgesia (p < 0.05). Further, 52% receiving fentanyl had a significantly better experience compared to their pre-procedure expectations as against 33% who received no analgesia (p < 0.05). No patient receiving fentanyl expressed unwillingness to undergo the procedure again using the same technique, whereas 16 (25%) of those receiving no analgesia indicated they would not (p < 0.01). Endoscopists recorded moderate/severe pain in 13 patients (12%), whereas 35 patients (32%) recorded moderate/severe pain (p < 0.001). Analgesia for endoscopy should involve patient choice. However, a single dose of 50 mcg fentanyl reduced patient discomfort and improved satisfaction. It appeared safe and likely to improve patient compliance and acceptability for flexible sigmoidoscopy.
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Affiliation(s)
- Sanjoy Basu
- Endoscopy Unit, St Mary's Hospital, PO30 5TG Isle of Wight, UK.
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Abstract
Multidetector technology, enabling faster imaging, higher spatial resolution and reduction in radiation dose, increases the role of CT in colonic diagnostic. The higher spatial resolution in the z-direction also changes the way to analyze the images. Instead of reading axial sections, now the colon can be systematically assessed in 3D by scrolling through multiplanar reconstructions or in CT colonography by virtual endoscopy. With ongoing improvements in computer-aided diagnosis CT colonography becomes an alternative to fiberoptic colonocopy for screening (http://www. multiorganscreening.org). In this article we propose a CT examination protocol for the colon, describe the typical imaging findings of different colonic diseases, and summarize the current status of CT colonography.
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Affiliation(s)
- W Luboldt
- Institute for Diagnostic and Interventional Radiology, J.W. Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Wolff RA. Chemoprevention for pancreatic cancer. INTERNATIONAL JOURNAL OF GASTROINTESTINAL CANCER 2004; 33:27-41. [PMID: 12909736 DOI: 10.1385/ijgc:33:1:27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
For a number of solid tumors, including pancreatic cancer, efforts aimed at disease prevention may be more successful than currently available anticancer treatments. While specific interventions are emerging to prevent breast, prostate, lung, and colorectal cancer, no trials of chemoprevention are being conducted in pancreatic cancer. Importantly, there are significant obstacles to the conduct of such research. However, preclinical and epidemiologic studies suggest that several drugs may have chemopreventive potential in pancreatic cancer. These include aspirin and other non-steroidal antiinflammatory drugs (NSAIDs), selective cyclooxygenase inhibitors, somatostatin analogs, selective estrogen receptor modulators (SERMs), and anti-androgenic agents. As the oncology community evaluates some of these agents in large chemoprevention trials for breast, colon, and prostate cancer, it may be found that pancreatic cancer prevention occurs as an unintended, but desirable consequence. Moreover, other general societal trends, such as smoking cessation and the widespread use of cholesterol-lowering agents and aspirin, could have a role in reducing the risk of pancreatic cancer, and in the future, may lead to a decrease in its incidence.
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Affiliation(s)
- Robert A Wolff
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Iannaccone R, Laghi A, Catalano C, Brink JA, Mangiapane F, Trenna S, Piacentini F, Passariello R. Detection of colorectal lesions: lower-dose multi-detector row helical CT colonography compared with conventional colonoscopy. Radiology 2004; 229:775-81. [PMID: 14657315 DOI: 10.1148/radiol.2293021399] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the performance of lower-dose multi-detector row helical computed tomographic (CT) colonography with that of conventional colonoscopy in the detection of colorectal lesions. MATERIALS AND METHODS One hundred fifty-eight patients underwent multi-detector row helical CT colonography (beam collimation, 4 x 2.5 mm; table feed, 17.5 mm/sec; voltage, 140 kV; and effective dose, 10 mAs) followed by conventional colonoscopy. Conventional colonoscopy served as the reference standard. Two radiologists interpreted CT colonographic images to assess the presence of polyps or carcinomas. Sensitivity was calculated on both a per-polyp and a per-patient basis. In the latter, specificity and positive and negative predictive values were also calculated. Weighted CT dose index was calculated on the basis of measurements obtained in a standard body phantom. Effective dose was estimated by using commercially available software. RESULTS CT colonography correctly depicted all 22 carcinomas (sensitivity, 100%) and 52 of 74 polyps (sensitivity, 70.3%). Sensitivity for detection was 100% in all 13 polyps 10 mm or larger in diameter, 83.3% in 20 of 24 polyps 6-9 mm, and 51.3% in 19 of 37 lesions 5 mm or smaller. With regard to the per-patient analysis, CT colonography had a sensitivity of 96.0%, a specificity of 96.6%, a positive predictive value of 94.1%, and a negative predictive value of 97.7%. The total weighted CT dose index for combined prone and supine acquisitions was 2.74 mGy. The simulated effective doses for complete CT colonography were 1.8 mSv in men and 2.4 mSv in women. CONCLUSION Lower-dose multi-detector row helical CT colonography ensures substantial dose reduction while maintaining excellent sensitivity for detection of colorectal carcinomas and polyps larger than 6 mm in diameter.
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Affiliation(s)
- Riccardo Iannaccone
- Department of Radiological Sciences, University of Rome-La Sapienza, Policlinico Umberto I, Viale Regina Elena 324, Rome, Italy 00161.
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Geenen RWF, Hussain SM, Cademartiri F, Poley JW, Siersema PD, Krestin GP. CT and MR colonography: scanning techniques, postprocessing, and emphasis on polyp detection. Radiographics 2004; 24:e18. [PMID: 14527992 DOI: 10.1148/rg.e18] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the last decade, computed tomographic (CT) and magnetic resonance (MR) colonography, two new cross-sectional techniques for imaging of the colon, emerged. Both techniques show promising initial results in the detection of polyps equal to or greater than 1 cm in diameter in symptomatic patients. Imaging protocols are still mostly under development and prone to change. Both CT and MR colonography generate a large number of source images, which have to be read carefully for filling defects and, if intravenous contrast material is used, enhancing lesions. An important postprocessing technique is multiplanar reformatting, which allows the viewer to see potential lesions in an orientation other than that of the source images. Virtual endoscopy, a volume rendering technique that generates images from within the colon lumen, is used for problem solving. CT and MR colonography have potential advantages over colonoscopy and double-contrast barium enema examination: multiplanar capabilities, detection of enhancing lesions that make the distinction between fecal residue and true lesion possible, and ante- and retrograde virtual colonoscopy. Currently, a number of studies suggest that patients have a preference for CT colonography over colonoscopy. Patients consider bowel cleansing the most uncomfortable part of any colon examination; hence, from the acceptance point of view, fecal tagging techniques are promising. Before CT and MR colonography can be implemented in daily practice, they must show approximately the same accuracy as colonoscopy for polyp detection in both symptomatic and screening patients.
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Affiliation(s)
- Remy W F Geenen
- Department of Radiology, Erasmus Medical Center, Dr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Heuschmid M, Luz O, Schaefer JF, Stuecker D, Vonthein R, Luboldt W, Claussen CD, Seemann MD. Comparison of volume-rendered and surface-rendered MR colonography. Technol Cancer Res Treat 2003; 2:13-8. [PMID: 12625749 DOI: 10.1177/153303460300200102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States and Europe, colorectal cancer is the second leading cause of cancer-related deaths. It is well known that colorectal carcinomas may originate from preexisting adenomas. For the visualization of colorectal cancer and other pathologic changes such as polyps, two 3D methods (volume-rendering (VR) and surface-rendering (SR)) in MR colonography were compared in our study. MR colonography was carried out in 17 patients on a 1.5 T MR scanner using a 10 mmolar gadolinium water solution enema. Coronal as well as rotated VR and SR views were compared in order to examine the technical quality (TQ) of the visualization model and grade of confidence (GC) in the pathological findings. Colonoscopic findings revealed 8 colorectal carcinoma, 10 patients with polyps, 4 diverticular disease, and 2 with redundant bowel loops. Based on a total of 248 colonic segments for both visualization methods, volume rendering were significantly superior to surface rendering for both, TQ (p<0.0001) and GC (p<0.0001). Volume rendering and surface rendering were not dependent on individual colon segments (p=0.13 for TQ and p=0.18 for GC) or on image rotation (p=0.06 for TQ and p=0.062 for GC). It is also independent of the type of pathology (p=0.31 for TQ and p=0.42 for GC) and the reviewers (p=0.62 for TQ and p=0.88 for GC). This indicates, that for the purpose of interpreting the technical quality and pathological findings, volume rendering is superior to surface rendering in MR colonography. Volume rendering could be used as an 3D visualization tool, enabling MR colonography examinations to be completed sooner in cases where colon distension is sufficient, and it would also provide an overview of potential mass lesions.
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Affiliation(s)
- Martin Heuschmid
- Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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Brotzman GL, Robertson RG. Colorectal Cancer. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Colorectal cancer is an important cause of morbidity and mortality among Western nations, and is more common in the elderly than in younger individuals. With the general acceptance of the adenoma-carcinoma sequence, the current consideration is that colorectal cancer is preventable if all adenomas are removed before they have the chance to progress to cancer. To that end, physicians should now advocate screening for colorectal cancer and through this effort a large number of patients with adenomatous polyps will be discovered. It is important to understand the strategy in dealing with this growing population of patients with adenomas. After an initial polypectomy, patients with adenomas should be entered into a surveillance program to detect and remove recurrent adenomas. Recommended surveillance intervals are shorter for patients with a family history of colorectal cancer, those with multiple adenomas (>2), large adenomas (> or = 1cm), or those whose adenomas have high-grade dysplasia, villous architecture, or that are cancerous. Effective chemoprevention would be a potential method of lengthening colonoscopic surveillance intervals. Unfortunately, no treatment has been found to be effective enough to alter our current surveillance practice. The only recommendation that can be made at this time for those patients with a history of colonic adenomas is to add 3 g/day of calcium carbonate to their diet, though its effect on adenoma recurrence is modest.
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Affiliation(s)
- Kenneth Miller
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, New York, USA
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Smith G, Carey FA, Beattie J, Wilkie MJV, Lightfoot TJ, Coxhead J, Garner RC, Steele RJC, Wolf CR. Mutations in APC, Kirsten-ras, and p53--alternative genetic pathways to colorectal cancer. Proc Natl Acad Sci U S A 2002; 99:9433-8. [PMID: 12093899 PMCID: PMC123158 DOI: 10.1073/pnas.122612899] [Citation(s) in RCA: 342] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Colorectal cancer is one of the most significant causes of cancer death. A genetic model for colorectal cancer has been proposed in which the sequential accumulation of mutations in specific genes, including adenomatous polyposis coli (APC), Kirsten-ras (K-ras), and p53, drives the transition from healthy colonic epithelia through increasingly dysplastic adenoma to colorectal cancer. We have characterized tumor mutation spectra in a large cohort of colorectal cancer patients. In marked contrast to the predictions of the sequential model of mutation accumulation, only 6.6% of tumors were found to contain mutations in APC, K-ras, and p53, with 38.7% of tumors containing mutations in only one of these genes. The most common combination of mutations was p53 and APC (27.1%), whereas mutations in both p53 and K-ras were extremely rare. Statistical analysis (two-sided Fisher's exact test) confirmed that mutations in K-ras and p53 co-occurred less frequently than expected by chance (P < 0.01, Fisher's exact test). This finding suggests that these mutations lie on alternate pathways of colorectal tumor development. The heterogeneous pattern of tumor mutations in our patient cohort suggests that multiple alternative genetic pathways to colorectal cancer exist and that the widely accepted genetic model of cancer development is not representative of the majority of colorectal tumors.
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Affiliation(s)
- Gillian Smith
- Cancer Research United Kingdom Molecular Pharmacology Unit, Biomedical Research Centre, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
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Janda M, Hughes K, Tong S, Stanton WR, Aitken J, Clavarino A, Short L, Del Mar C, Leggett B, Newman B. Faecal occult blood test: current practice in a rural Queensland community. Aust J Rural Health 2002; 10:57-64. [PMID: 11952524 DOI: 10.1046/j.1440-1584.2002.00433.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The findings of a recent telephone survey of 604 residents (50-74 years of age) in a rural community in Queensland are presented. The survey focused on the participants' knowledge concerning the faecal occult blood test (FOBT) and their previous testing history. Responses were analysed in terms of gender, age and education differences. More than half of all participants were aware of the FOBT, and 109 (18%) had undergone FOBT in the past. Fewer understood the importance of "health checks without symptoms" than the "advantage of early treatment". The most common reasons to use FOBT were: "prevention" and "I want to know if I have cancer". A person's gender, age and education were shown to be associated with their knowledge and beliefs. These results suggest an increase in the use of the FOBT with time (in relation to previous surveys), but a poor understanding of its place in promoting health.
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Affiliation(s)
- Monika Janda
- Centre for Public Health Research, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland 4059, Australia
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Abstract
Colorectal cancer is an important health problem in western countries. Early detection of colorectal cancer reduces mortality. The best evidence for the effectiveness of screening for colorectal cancer is with annual or biennial fecal occult blood testing. While the benefit of fecal occult blood testing is small in absolute terms, the incremental cost-effectiveness of this screening strategy appears acceptable. Combining fecal occult blood testing with periodic flexible sigmoidoscopy or replacing it altogether with infrequent colonoscopy are theoretically attractive screening strategies, but the incremental costs and effectiveness of these more intensive screening strategies have not been well defined. Whether and how to implement population-based screening for colorectal cancer depends largely on available resources.
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Affiliation(s)
- M J Barry
- Medical Practices Evaluation Center, Massachusetts General Hospital, Boston, USA.
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Affiliation(s)
- P Autier
- Centre for Research on Epidemiology and Health Information Systems (CRESIS), Luxemburg.
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Colorectal Cancer Screening and Surveillance. COLORECTAL CANCER 2002. [DOI: 10.1007/978-3-642-56008-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVE To describe the role of celecoxib as adjunctive therapy in the treatment of familial adenomatous polyposis (FAP), an inherited autosomal dominant predisposition syndrome for colorectal cancer. DATA SOURCES Literature was evaluated through MEDLINE search (1995-March 2000) and through secondary sources, using the search terms celecoxib, cyclooxygenase-2 inhibitors, and familial adenomatous polyps. DATA SYNTHESIS Observational studies have found a decreased rate of colorectal cancer in people who regularly took aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs). The Food and Drug Administration granted accelerated approval in December 1999 for the NSAID celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, for adjunctive therapy in patients with FAP, based on a six-month, randomized, controlled clinical trial. CONCLUSIONS Aspirin and other NSAIDs reduce the incidence of colorectal cancer in the general population. Limited clinical studies in patients with FAP using nonaspirin NSAIDs have shown a reduction in polyp burden. A current clinical trial using celecoxib has also shown a reduction in polyp burden in patients with FAP. The long-term clinical impact of using a selective COX-2 inhibitor is not known, since celecoxib has not been studied beyond six months in patients with FAP. By reducing the polyp burden in FAP patients, celecoxib may be useful as adjunctive chemotherapy, in addition to routine endoscopic surveillance and surgery.
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Affiliation(s)
- G L North
- School of Pharmacy, University of Montana, Missoula, MT, USA.
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Fava TA, Desnoyers R, Schulz S, Park J, Weinberg D, Mitchell E, Waldman SA. Ectopic expression of guanylyl cyclase C in CD34+ progenitor cells in peripheral blood. J Clin Oncol 2001; 19:3951-9. [PMID: 11579116 DOI: 10.1200/jco.2001.19.19.3951] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the utility of guanylyl cyclase C (GC-C)-specific nested reverse transcriptase polymerase chain reaction (RT-PCR) to detect circulating tumor cells in patients with colorectal cancer. PATIENTS AND METHODS Peripheral-blood mononuclear cells from 24 patients with Dukes' stage D colorectal cancer were analyzed by GC-C-specific nested RT-PCR using 1 microg of total RNA. Peripheral-blood mononuclear cells from 20 healthy volunteers served as controls. Additionally, peripheral-blood CD34+ progenitor cells were assayed for the expression of both GC-C and other epithelial cell-specific markers. RESULTS GC-C mRNA was detected in blood mononuclear cells from all 24 patients with colorectal cancer and all healthy volunteers. These unexpected positive results reflected low-level ectopic transcription of GC-C in CD34+ progenitor cells. Moreover, CD34+ progenitor cells expressed other epithelial cell-specific markers, including prostate-specific antigen, prostate-specific membrane antigen, carcinoembryonic antigen, CK-19, CK-20, mucin 1, and GA733.2. Limiting the quantity of mononuclear cell total RNA analyzed to < or = 0.8 microg eliminated detection of GC-C and other tissue-specific transcripts in blood of healthy volunteers. However, under the same conditions, GC-C mRNA was detected in mononuclear cells from all 24 patients with metastatic colorectal cancer. Using 0.5 microg of total RNA and GC-C-specific primers, nested RT-PCR detected a single human colon carcinoma cell (approximately 20 to 200 GC-C transcripts/cell) in 10(6) to 10(7) mononuclear blood cells. CONCLUSION These data suggest that GC-C may be useful for detecting circulating colorectal cancer cells. They also demonstrate that CD34+ cells are a source of ectopically expressed epithelial cell-specific markers and that CD34+ cells may contribute to the high false-positive rate generally observed when those markers are used to detect rare circulating metastatic cancer cells by RT-PCR.
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MESH Headings
- Adult
- Aged
- Antigens, CD34/blood
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Carcinoembryonic Antigen/blood
- Colorectal Neoplasms/blood
- Colorectal Neoplasms/enzymology
- Colorectal Neoplasms/pathology
- Epithelial Cells/enzymology
- Female
- Granulocyte Colony-Stimulating Factor/therapeutic use
- Guanylate Cyclase/biosynthesis
- Guanylate Cyclase/blood
- Guanylate Cyclase/genetics
- Hematopoietic Stem Cells/enzymology
- Humans
- Leukocytes, Mononuclear/enzymology
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Staging
- Neoplastic Cells, Circulating/metabolism
- RNA, Messenger/blood
- Receptors, Enterotoxin
- Receptors, Guanylate Cyclase-Coupled
- Receptors, Peptide/biosynthesis
- Receptors, Peptide/blood
- Receptors, Peptide/genetics
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- T A Fava
- Division of Clinical Pharmacology, and Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Heinzlmann M, Neynaber S, Heldwein W, Folwaczny C. K-ras and p53 mutations in colonic lavage fluid of patients with colorectal neoplasias. Digestion 2001; 63:229-33. [PMID: 11435722 DOI: 10.1159/000051894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The adenoma-carcinoma sequence has its molecular basis in several gene mutations of which K-ras and p53 are of paramount importance. The aims of this study were to evaluate whether these genetic alterations can be detected in colonic lavage fluid from patients with colorectal adenomas and carcinomas. METHODS In 45 patients with adenomas, 20 patients with colorectal carcinomas and 38 patients with non-neoplastic and noninflammatory diseases of the colon p53 and K-ras mutations were evaluated in colonic lavage fluid employing single-strand confirmation polymorphism analysis and dot-blot hybridization, respectively. RESULTS Mutations of the K-ras and the p53 gene were found in 15.6% (p = 0.065) of patients with adenomas, in 25.0 % (p = 0.016) of patients with carcinomas and in 2.6% in the control group. CONCLUSION Genetic alterations in the colonic lavage fluid could be an additional diagnostic tool for the surveillance of patients with colorectal neoplasias.
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Affiliation(s)
- M Heinzlmann
- Department of Gastroenterology, Medizinische Klinik Innenstadt, Ludwig-Maximilians-Universität, München, Germany
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Luboldt W, Luz O, Vonthein R, Heuschmid M, Seemann M, Schaefer J, Stueker D, Claussen CD. Three-dimensional double-contrast MR colonography: a display method simulating double-contrast barium enema. AJR Am J Roentgenol 2001; 176:930-2. [PMID: 11264080 DOI: 10.2214/ajr.176.4.1760930] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- W Luboldt
- Department of Radiology, University Hospital Tuebingen, Hoppe-Seylerstr. 3, D-72076 Tuebingen, Germany
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Stern HS, Viertelhausen S, Hunter AG, O'Rourke K, Cappelli M, Perras H, Serfas K, Blumenthall A, Dewar D, Baumann E, Lagarde AE. APC I1307K increases risk of transition from polyp to colorectal carcinoma in Ashkenazi Jews. Gastroenterology 2001; 120:392-400. [PMID: 11159880 DOI: 10.1053/gast.2001.21170] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS The I1307K allele of the APC gene has been shown to confer a modestly elevated risk of colorectal cancer in the Ashkenazi Jewish population (relative risk, 1.5-1.7). However, it is unclear whether the alteration predisposes to adenomas and whether the genetic information can be used in clinical practice. To further address the pathogenic significance of I1307K, we offered both a genetic test and a screening program to individuals considered to be at increased risk for colorectal cancer. We compared the prevalence of polyps and their characteristics between carriers and noncarriers. METHODS Invitations to participate in a DNA and colonoscopy screening program were mailed, together with a family questionnaire, to 3540 households forming the Jewish Community in Ottawa. The I1307K variant was analyzed in 242 eligible respondents who were selected because they had a personal or family history of colon cancer. Nearly 80% of these respondents (n = 189; age range, 32-83 years) consented to undergo a single colonoscopic examination. RESULTS The overall carrier frequency of I1307K in the study group was 10.3%. A higher proportion of heterozygous gene carriers was found in the subgroup of colon cancer survivors (27%) than among asymptomatic individuals (8%, P < 0.02). A total of 59 polyps were identified in 44 subjects. Histologically confirmed adenomatous polyps were diagnosed in 11.8% of carriers and 12.8% of noncarriers (P > 0.5). No significant differences in polyp size, multiplicity, location, degree of villosity, or age-dependent prevalence were found between the 2 groups of participants. CONCLUSIONS The high frequency of I1307K colorectal cancer patients found in the Ashkenazi Jewish community of Ottawa and the equivalent proportion of carriers and noncarriers who developed adenomatous polyps suggest that in this community, I1307K is associated with a significant predisposition to carcinoma but not adenoma.
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Affiliation(s)
- H S Stern
- Loeb Health Research Institute, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada.
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Esplen MJ, Madlensky L, Butler K, McKinnon W, Bapat B, Wong J, Aronson M, Gallinger S. Motivations and psychosocial impact of genetic testing for HNPCC. ACTA ACUST UNITED AC 2001. [DOI: 10.1002/ajmg.1493] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Riedel JE, Lynch W, Baase C, Hymel P, Peterson KW. The effect of disease prevention and health promotion on workplace productivity: a literature review. Am J Health Promot 2001; 15:167-91. [PMID: 11265580 DOI: 10.4278/0890-1171-15.3.167] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This report was prepared by the Center for Disease Prevention and Health Promotion in the Institute for Health and Productivity Management as part of an effort to improve understanding of the connection between employee health and performance and to begin to identify new strategies through which treating health as an investment in human capital can lead to greater business success. Computer database searches of peer-reviewed literature published between 1993 and 1998 and manual reviews of 20 journals were used to identify research on the link between employee health and performance. Data was extracted to summarize the overall findings on the magnitude of health problems addressed by health promotion and disease prevention programs, and the impact of interventions on improving health risk, reducing medical care cost, and improving worker performance. From this summary, major conclusions on early detection of disease, the impact of behavior change programs, and appropriate care-seeking were drawn. This systematic review is supplemented with summaries of 15 seminal articles and descriptions of five leading-practices programs. The influence of developments in work/family issues, complementary and alternative medicine, and quality of care and health outcomes research are briefly discussed. Finally, a conceptual framework for studying the impact of health and productivity is described.
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Affiliation(s)
- J E Riedel
- Riedel & Associates, Conifer, Colorado, USA
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